A Review of Anatomical Considerations for the Surgical Treatment of Lateral Femoral Cutaneous Nerve Entrapment

Introduction: Lateral femoral cutaneous nerve (LFCN) entrapment is a condition that occurs due to the compression of LFCN. Incidence is estimated to be 4.3 new cases/10,000 individuals/year. LFCN arises from lumbar L2-L3 roots, pierces the lateral border of the psoas major muscle, crosses superior to anterior superior iliac spine (ASIS), and inferior to inguinal ligament. LFCN entrapment commonly occurs when the nerve exists the pelvis, resulting in neuropraxia, axonotmesis, and neurotmesis. In the thigh, LFCN travels superior to sartorius muscle, pierces the fascia lata, and provides sensation to the anterolateral thigh. The clinical manifestations of LFCN include dysesthesia of the anterolateral thigh. Unilateral symptomatology is most commonly observed, but bilateral manifestation can occur in 20-50% of the cases. Treatment consists of neurolysis, neurectomy, and injections. Anatomical variations of LFCN may be associated with incomplete pain relief following standard therapy. We examine the relationship between LFCN anatomical patterns and symptomatic pain relief following treatment.

Methods: A review of the literature was conducted, utilizing PubMed, Google Scholar, EMBASE, and Cochrane Library. Furthermore, we present a unique case of LFCN entrapment to illustrate our findings.

Results: Contemporary data of LFCN entrapment suggests that neurectomy achieves better pain relief compared to neurolysis. LFCN transposition is a novel surgical technique that has demonstrated significant symptomatic relief. The combination of LFCN transposition following neurolysis has been demonstrated to improve decompression. This suggests the anatomical course of the LFCN may be as significant of a factor as the ASIS course in decompression.

Conclusion : It has been shown that the LFCN bifurcates in up to 38% of clinical presentations prior to the ASIS suggesting the need for greater anatomical consideration for symptomatic pain relief. This can be achieved using ultrasound to localize the LFCN course during treatment.

Further attention to anatomical variations should be given to improve treatment outcomes following LFCN entrapment.